Depression ... or Just the Blues?

It is a common question -- one that you may have even asked yourself from time to time -- but the answer may be more complex than you think.

You may wonder whether you have had depression yourself, or you may have had a depressive episode already but consider it normal.

Even at the clinical level, proper diagnosis of depression can sometimes be a challenge. Just last week, a new study published in the journal The Archives of General Psychiatry suggested that about one in four people diagnosed with depression might instead be struggling with emotions associated with the loss of a loved one or a job, or some other event in the person's life.

The researchers suggested that those emotions, though profound, should not usually be diagnosed as depression.

However, many people think they know what depression is because the word is used in common parlance to mean "sadness."

True, sadness can indeed be a symptom of clinical depression or major depression, but when psychiatrists think of depression, we think of what is called a syndrome -- meaning a collection of signs (what other people can see) and symptoms (what a person feels) that occur together.

Depression Goes Beyond Sadness

The most obvious symptom of depression is the abnormal mood, which is often sadness. But surprisingly, your mood does not have to be sad. Often, rather than being sad, when they are depressed, people say they feel empty, or feel nothing, or feel numb. Rather than bad feelings, there are no feelings.

People often lose the ability to enjoy things; even sex, the universal pleasure, loses its appeal. Their favorite hobbies, such as sailing or dancing, no longer excite them.

They may feel badly about themselves, believing that they do not deserve to be happy, or they may feel guilty for no good reason, blaming themselves for something of little consequence, or for which they had no role. One patient believed he should have been able to prevent the World Trade Center attack. This sort of irrational belief is referred to as a delusion, and occurs in about 15 percent of depressions.

James Potash is an associate professor of psychiatry and co-director of the Mood Disorders Program (http://www.hopkinsmedicine.org/moods) at the Johns Hopkins School of Medicine in Baltimore. If you have questions or comments, please e-mail at moods@jhu.edu. To participate in our studies, call 1-877-MOODS-JH.

Energy is often low. Sleep is often disrupted, with a common pattern being trouble sleeping at night, and excessive sleeping during the day. Appetite often decreases with a loss of weight, though sometimes people eat too much and gain weight.

An underappreciated aspect of depression is the degree to which thinking can be impaired. People have trouble concentrating and often cannot read or retain what they read. One patient whose job involved running complex computer programs sat in front of her computer for months unable to figure out which buttons to push. People may be slowed down and look like molasses, or conversely, they may appear nervous and agitated, wringing their hands and pacing.

The Danger of Suicide

The most worrisome symptom of all is suicidal thoughts. People with depression often think about death.